From Concussions to Superbug Discussions

Originally published in the National Post, December 20, 2011.

If there was one major medical theme over the past 12 months, it was the ongoing health toll of cancer.

The early months of 2011 gave us a feel-good story as the seemingly indefatigable politician Jack Layton bounced back from prostate cancer to lead the Official Opposition in Parliament - only to succumb to another cancer just three months after the election. Next was the tech innovator Steve Jobs, who died of pancreatic cancer in October. And just last week, renowned contrarian Christopher Hitchens was silenced by a complication - pneumonia - of esophageal cancer.

But not all medical stories were sad in 2011. Medical science was its usual turbulent self, offering major stories and minor miracles. The following are the trends that stuck out for me over the past 12 months:

SCREENING CONTROVERSIES

In November, the Canadian Task Force on Preventive Health Care issued new breast cancer screening guidelines that cut back the suggested frequency of mammograms. The news followed the U.S. Preventive Task Force's edict that healthy men aged 50 to 69 shouldn't be screened for prostate cancer with the PSA test. Many disagree with both recommendations. Individuals want choice when it comes to their personal health - particularly when it comes to early cancer detection.

Such screening controversies are certain to stick around in 2012 as cash-strapped health ministries respond to tighter budgeting by searching for medical services they can "de-list" - or stop covering with public insurance.

YOUR OFFICE JOB IS KILLING YOU

You know that leg-twitcher who drives you crazy during your weekly managerial meeting? Turns out his fidgeting is good for him. Yes, 2011 was the year that we woke up to the health toll of sitting all day. So-called "sedentary studies" turned a corner, going from neglected research area to hot topic.

"On average, most adults spend seven to 10 hours per day in sedentary behavior, with workplace sitting often occupying the large majority of this time," observed the American Journal of Preventive Medicine this summer.

A growing body of evidence suggests that all-cause mortality increases the more time we sit - and that the effects of all that sitting aren't necessarily counteracted by regular exercise.

HEAD INJURIES

Before 2011, it might have been possible to cheer a fight at a hockey game. But by the end of this year far too many NHL stars were kept out of the sport they love by the prospect of head trauma.

Sidney Crosby, Chris Pronger and Claude Giroux all are out in a year that also saw the deaths of former enforcers Derek Boogaard, Wade Belak and Rick Rypien. Were the enforcers' health affected by all the head trauma they received during years spent doling out and receiving haymaker punches? Repeated concussions have been associated with such conditions as dementia pugilistica. Treatment for concussions is limited to cognitive and physical rest.

One thing's for certain. Medical science is trying to better manage concussions, with increasingly popular diagnostic tools, such as the ImPACT online assessment, and ongoing research on brain physiology and imaging. What's up for 2012? Hopefully, our pro sports get better at preventing concussions in the first place.

INFECTIOUS DISEASE

Most of 2011 was alternately scary and frustrating when it came to the world of infectious disease. We heard about the New Delhi superbug, a gene called ND-1, which spread to Canada and other countries via micro-organisms. And irrational skepticism over things like the measles vaccine led to an epidemic of 250 measles cases in Quebec.

Thankfully, the year in infectious disease ended on a high note: Researchers leading a study in sub-Saharan Africa announced this fall that human trials of a malaria vaccine, the first ever for a parasiteborne illness, was 56% effective in preventing the disease.

WHAT'S COMING UP?

Canada will mark the 50th anniversary of the country's first example of universal healthcare: Saskatchewan premier Tommy Douglas's universal provider system took effect in that province July 1, 1962. A half-century later our system is shuddering under the weight of ever-climbing healthcare budgets and the effects of an ageing population.

The discussion at a recent Harvard conference I attended suggested physicians like myself will be under increasing pressure to act as gatekeepers who limit the care they provide to their patients.

I'd prefer physicians keep patient care top of mind rather than budget constraints - so here's hoping we find brighter ways to reform our healthcare system over the next 12 months.